- Centene Corporation (Austin, TX)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Centene Corporation (Little Rock, AR)
- …based on diagnoses, prognoses, resources, and/or preferences + Manages and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Provides education to providers on… more
- ProgenyHealth (Elk Grove Village, IL)
- …Clinical care nurses coordinate overall member care, from pre-admission, continued stay ( concurrent review ) and any outpatient services utilizing a pro-active, ... attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for...Three or more years of experience working in a concurrent review or discharge planning role within… more
- Access Dubuque (Dubuque, IA)
- Nurse -Clinical Document Specialist - Remote **MercyOne** 1 Positions ID: TRHEUS00496408MERCYO Posted On 04/17/2024 **Job Overview** **Employment Type:** Full ... accuracy, and integrity of medical record documentation through extensive record review . Through extensive interaction with physicians and other members of the… more
- Trinity Health (Dubuque, IA)
- …accuracy, and integrity of medical record documentation through extensive record review . Through extensive interaction with physicians and other members of the ... provider engagement. Identifies learning opportunities for healthcare providers. Conducts concurrent reviews of selected patient health records to address… more
- Actalent (Tampa, FL)
- Actalent is hiring a Clinical Review Nurse for a fully remote role! In this role you are primarily responsible for Utilization Review and Concurrent ... Review of post-acute care. Requirements Must have compact RN license 5 years of nursing experience (1-2 years of acute nursing required) Telephonic case management/triage experience Schedule Sunday-Thursday 9am-6pm EST About Actalent Actalent is a global… more
- Fallon Health (Worcester, MA)
- …fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. The UM Nurse uses a multidisciplinary approach to organize, coordinate, monitor, evaluate and modify ... complex medical and psychosocial needs of FH members and their families. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient medical… more
- Intermountain Health (Murray, UT)
- …coordination of transition of care and manage utilization through appropriate review of authorization requests. Job Essentials Analyzes and evaluates medical records ... clinical criteria while adhering to regulatory turn-around times and provide review outcomes to members and providers in accordance with notification standards.… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II - Medium Acuity - CMHHIP - Pueblo - $14,000 Sign On Incentive Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4365852) Apply ... Registered Nurse II - Medium Acuity - CMHHIP - Pueblo...over. This population of patients have psychiatric disorders with concurrent criminal involvement or are highly dangerous, requiring inpatient… more
- State of Colorado (Pueblo, CO)
- Registered Nurse I - Fixed Pool - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4478703) Apply Registered Nurse I - ... with Adolescents and Adults. This position is a part-time Nurse on the Fixed Pool and will have the...campus. Patients on these units have psychiatric disorders with concurrent criminal involvement or are highly dangerous, requiring inpatient… more
- Trinity Health (Newtown, PA)
- …Trinity Health Mid-Atlantic is looking for an experienced Revenue Integrity Nurse Auditor to join our team! Hybrid Schedule: Full-time, Monday-Friday (4 ... days remote , 1 day on-site) Location: 41 University Drive Newtown,...reporting to key stakeholders; + Reviews and understands utilization review and coverage guidelines for multiple payers; + Identifies… more
- HCA Healthcare (Houston, TX)
- …HCA Houston Healthcare Northwest!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including Core ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current role?...Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- CVS Health (Columbus, OH)
- …1 year of varied UM (utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization. + 5 years of a variety ... care more personal, convenient and affordable. Position Summary 100% remote position from anywhere in the US Work hours:...who will be joining our reconsideration team. A reconsideration nurse will review any additional information submitted… more
- HCA Healthcare (Kingwood, TX)
- …HCA Houston Healthcare Kingwood!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including Core ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current role?...Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- Albany Medical Center (Albany, NY)
- …financial constraints. c. Provides collaborative care management with the primary nurse in assessing for discharge planning needs, coordinating appropriate resources ... in the referral process and use of community resources. 2. Utilization Review a. Reviews data from admission screening to clarify admission diagnosis, establish… more
- CVS Health (Salem, OR)
- …1 year of varied UM (utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization. 5 years of a variety ... more personal, convenient and affordable. Requisition Job Description 100% remote position from anywhere in the US Work hours:...with providers to secure information required for prior authorization review . They may also work in a clinical call… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Title:** Nurse Senior_ Utilization Management Lead **Shift** : M-F 8hr days/Hybrid (2 days ... Remote , 3 days in Office) **Position Summary** : The...upholding and developing standardized processes around, Utilization Management, both concurrent and retrospective for both Inpatient and Outpatient services… more
- Mayo Clinic (Rochester, MN)
- …Two years of experience in an Inpatient Clinical Documentation Integrity Specialist (ICDIS) role, concurrent review of medical records in the field of ICDI and ... analyze current documentation to identify gaps. Identifies opportunities in concurrent and retrospective inpatient clinical medical documentation to support quality… more
- AdventHealth (Altamonte Springs, FL)
- …we are even better. **Shift** : Monday-Friday **Job Location** : Remote **The role you'll contribute:** The Clinical Documentation Integrity (CDI) Implementation ... current employees in the CDI Department. . Audits CDS concurrent and retrospective cases to assist with missed documentation...all CDI software platforms, providing follow-up on site and remote support for all participating facilities. . Assist in… more
- Providence (OR)
- …Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization, Medical Audits, Appeals or ... nearing end of life + **Care management services include:** nurse education, care coordination and general assistance with managing...and quality care to our members **_We welcome 100% remote work for residents who live in the following… more